Sleep Apnea Claim

[EODCMC]

Hi, I am a 30 year retired vet. I retired 13 years ago. I as recently diagnosed with "very severe" obstructive sleep apnea. The machine they gave me is preset on the highest output flow. My episode exceed 35 times an hour with some lasting more than 30 seconds. 

I was diagnosed with sleep apnea a couple of years prior to retirement and the study and diagnosis is documented in my record. In fact, they wanted to operate on my uvula. There lies the rub. The operation could have ended my career so I didn't persue. Additionally, while on active duty I developed severe chronic sinusitis and allergic rhinitis and this also is documented in my service health record. I have been living with this and chalking it down to getting old.

Fast forward...I recently got a machine that they say I have to wear for the remainder of my life. I just learned that Tricare Prime does not pay for it all. So, I researched online and submitted a claim the E-benefits and it has been received and was under review until today when they changed this to "gathering of evidence" Development Letter Sent.

Does anyone know what this means? What do I have to look forward to concerning the process. I watch the news. It doesn't look good, right?

thanks in advance.

[pepperD]

EODCMC,

I can certainly help you with this. Awarded SA claim came through for me this summer.  I too was diagnosed on AD, but didn't get a Bipap until 2 years ago.  Took VBA another 1.5 years to award claim, and I was successful through Board of Vet Appeals.  I did a few things to prepare for BVA while they were gathering eveidence. #1 was I researched similar claims that BVA had awarded/granted compensation for the vet with SA.  There are hundreds of similar case to ours.  Then I had my Sleep doctor sign a nexus letter after he reviewed my military records and he concluded that SA was diagnosed and symptoms were the same / worse than when I was on AD.  Show disease progressed.  I send in letters to the Regional office handling my case by uploaded through eBenefits.  #3, I went through my military med records and found each time I complained to a doctor about symptoms of SA.  Put all that into another letter and uploaded to my claim.  Well worth the effort.

 

As for going to the VA sleep clinic, they wouldn't touch me until VBA granted SA claim.  I did read somewhere that after your awarded you can do a claim for the part tri-care didn't pay for your machine.  Sleep lab may be able to help you with that info, or maybe Prosthetics department.

 

Best wishes

[EODCMC]

Nothing in my account yet. Oh well, keep piling it up. Maybe they are waiting for the 1st of the month.

[EODCMC]

Thanks Pepper. Yes, I think mine was a slam dunk, except for the time between studies. I'm still concerned about the low partial pressures of 02. I feel like I'm out of breath just going for the 5 wizzes at night. That might be getting adjusted to the face mask each time. Not so much when I'm up and about. That plus tingling in the legs...again only a night. 

I have no idea why I'm whining though. There are folks here that deserve our concern...and admiration.

Anyway, thanks again. I'll look into getting paid back for my portion of the CPAP. That was my initial reason to begin with. 

Ive gotten some excellent advice along this relatively short journey props to Gastone, Andy, Buck and of course Berta.

[Andyman73]

EODCMC

That's great news.  I have no hopes for my own SA claim, tho.  Other than a few notations on health surveys in my SMR, and one note of sleep troubles during a dr visit, I have no real documentation to support me.  I was hoping to tie it in with my MH claim...but that too, seems to be stuck at the outer marker.  So I will be enjoying the 3-5 yr appeals process on those...if I can

[Buck52]

Andyman73

Did you get  denied for Sleep Apnea?

You sure don't want to give up b/c you were denied  keep fighting them.

if you have MH problems (Depression) you just need to find the right Dr to state your MH problems do effect your OSA...study's have shown it can cause/aggravate  OSA problems, just as well as PTSD and medications can be  related to OSA.

You just need to find a Dr that will connect the two...and since your already on The Bi-pap  or C-pap machine  that will be hard for them to deny you...the nexus is all you need   it can be secondary to your  MH S,C, Disability.

check with Attorney Chris Attig

[Andyman73]

Buck,

Yeah, got denied for the sleep apnea and MDD as well.  I appealed both, and will know something more in 3-5 years, I guess. 

I spoke to a NOVA lawyer not too long ago...and got turned away, 4th time wasn't the charm for me.

My VA MH doctor told me that he can't help me as per the law and regulations(help with my claims, not the therapy itself), as far as which way to go and such.  And as per same regs can't even write an IMO. 

The P.A. who my sleep apnea file is assigned to, at my private sleep clinic, doesn't believe that pain can disrupt sleep enough to be a factor in SA.

I previously contacted Mr. Attig's office, was turned down by him, and the firm they recommended, and H&P as well. 

It's hard enough just trying to live, to do my job well, to keep the wife happy(no success there), be a good daddy, and son, without having to fight the VA. It's no surprise that the results of my neurological exam(at the VA)showed marked memory loss issues. 

Yes I've had a few wins with claims, but they're the small ones, the big ones elude me. Every denial adds more "weight" to my load, at this point I just want to dump that load off my back.  I don't even want to think of asking for help anymore, because I know I can't get turned away if I don't ask.